Asian Pacific Islander Community Research Articles

WHAT PANDEMIC RECOVERY WILL LOOK LIKE FOR OLDER, MULTICULTURAL WORKERS

Abstract It is no surprise to many that the impact of Covid-19 on older adults, particularly LGBTQ and people of color has been detrimental, not just physically, but mentally, socially, and economically. Many African American/Black adults have suffered disproportionately during the pandemic. In terms of Social Security more than nine in 10 (93%) older Black Americans report that having adequate Social Security benefits is important, but for the many who were forced to retire early due to the pandemic, they will be at a disadvantage. LGBTQ older adults experience persistent discrimination due to sexual orientation or gender identity. When the LGBTQ individual was African American/Black, experiences of discrimination were higher and often occurred in the workplace. These forms of discrimination are directly impacts ones earning potential both during active work years and in retirement savings. AARP has a long history of being an advocate for marginalized and vulnerable adults. AARP staff will discuss policy needs and what the post pandemic workplaces needs to ensure that older LGBTQ people can thrive in the workplace with dignity and respect. The 2021 AARP’s Vital Voices research will be used to showcase the economic impact the pandemic has had on older adults, African American communities, Hispanic/Latino communities, Asian Pacific Islander communities and LGBTQ communities. AARP staff will discuss strategies and tactics needed to ensure that opportunities for economic recovery for older adults. The survey gathers information to gauge opinions on a range of topics as well as breaking and current issues.

WHAT PANDEMIC RECOVERY WILL LOOK LIKE FOR OLDER, MULTICULTURAL WORKERS

Abstract AARP has a long history of being an advocate for marginalized and vulnerable adults. AARP staff will discuss policy needs and what the post pandemic workplaces needs to ensure that older LGBTQ people can thrive in the workplace with dignity and respect. The 2021 AARP’s Vital Voices research will be used to showcase the economic impact the pandemic has had on older adults, African American communities, Hispanic/Latino communities, Asian Pacific Islander communities and LGBTQ communities. AARP staff will discuss strategies and tactics needed to ensure that opportunities for economic recovery for older adults. The survey gathers information to gauge opinions on a range of topics as well as breaking and current issues. Among other issues, it explores concerns about racism and experience with age discrimination and employment experience among older adults.

Abstract PO-021: A hub and spoke model to improve cancer care quality: Advancing Cancer Care Together (ACCT) for Asian American Medicaid beneficiaries in Orange County, California

Abstract Introduction: Orange County (OC) is home to the third-largest population of Asian Americans in the U.S., including the largest population of Vietnamese outside of Vietnam. While breast, lung and colorectal cancers are the top overall causes of cancer incidence and mortality in OC, unique cancers are prevalent among Asian and Pacific Islanders including liver and stomach cancers. The University of California, Irvine Chao Family Comprehensive Cancer Center (UCI CFCCC) adapted a hub-and- spoke model of care (Elrod & Fortenberry, 2017) to increase efficiency among underserved Asian Americans who continue to experience disparities in screening, early detection, and access to cancer treatment. Methods: Our hub-and-spoke model arranges service delivery assets into a network between community organizations through culturally/linguistically competent and trained community health navigators, OC medicaid primary and specialty care providers for low/moderate complexity patients, and UCI CFCCC for high-complexity cancer treatment. UCI CFCCC serves as the anchor establishment (hub) which offers a full array of services. This is complemented by community providers and care coordinators at local Federally Qualified Health Centers (spokes) which offer culturally-tailored primary prevention services. The community patient navigators (rim) located at community-based organizations, routes patients needing more tailored services to the spokes or hub for screening or treatment. Results: Patient Navigators at OC Herald Center, OC Asian Pacific Islander Community Alliance, and Vietnamese American Cancer Foundation have educated 2,246 Korean, Vietnamese, and Chinese individuals on cancer prevention and screening guidelines. Of those, 320 medicaid members have been routed to KCS Health Centers (Korean-serving FQHC lookalike), Southland Integrated Services, Inc (Vietnamese and Chinese-serving FQHC), or Medicaid community providers for cancer screening and/or follow-up. 64 community providers have been trained on NCCN guideline adherent care for Korean, Vietnamese, and Chinese. UCI CFCCC has developed an algorithm/pathway for Medicaid-serving community physicians to easily refer qualified Vietnamese, Chinese, or Korean patients to the hub for complex care or clinical trials. Conclusions: The current COVID-19 pandemic has exacerbated disparities in screening and early detection, and compounds the uncertainty about the importance of optimizing cancer care quality (i.e. access proportion and timeliness, adherence to guidelines, patient satisfaction). Disparities being highlighted in COVID-19 has shown us the power and need of community engagement models to rapidly catalyze and create unique community-based efforts that strengthen capacities and infrastructures, and promote best practices in cancer prevention and early detection designed to decrease cancer incidence and/or mortality in the communities we serve. Citation Format: Cevadne Lee, Ellen Ahn, Mary Anne Foo, Sherry Huang, Becky Nguyen, Tricia Nguyen, Jacqueline Tran, Robert Bristow, Sora Park Tanjasiri. A hub and spoke model to improve cancer care quality: Advancing Cancer Care Together (ACCT) for Asian American Medicaid beneficiaries in Orange County, California [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-021.

Abstract TMP55: Understanding Cultural and Knowledge Barriers to Acute Stroke Care in the Filipino American Community

Introduction: Filipino Americans (FilAms) in Los Angeles make up the largest Filipino community outside of the Philippines and 2nd largest Asian subgroup in L.A. County. FilAms also have higher rates of stroke, high blood pressure, and diabetes not only compared to other Asian subgroups but also to African American and Latino communities. Little is known about FilAm knowledge and cultural barriers in accessing acute stroke care. Methods: Using a qualitative descriptive design, we studied knowledge, attitudes, and health behaviors of the L.A. FilAm community with regard to acute stroke care by conducting 5 focus groups of 5-7 people each and 6 semi-structured interviews with key community leaders. Participants were recruited through L.A. FilAm community organizations. Focus groups were organized as follows: 1st: elderly community members at high stroke risk; 2 nd : spouses of those at high stroke risk; 3 rd : paid caregivers of those with stroke risk; 4 th : unpaid caregivers of those with stroke risk; 5 th : young FilAms with family members with stroke risk. Six individual interviews were with elderly FilAms identified as exceptionally healthy by community leaders. We conducted thematic analysis, coding for themes on barriers to acute stroke care. Results: Two key themes have emerged: 1) spiritualistic fatalism and the belief that God is in control of all outcomes despite an individual’s will and 2) fear of calling 911, specifically linked to shame in being perceived as unhealthy by neighbors, fear of deportation among undocumented FilAms, and fear of high ambulance cost. Elderly participants perceived social media as one of the most effective ways to widely engage FilAms on stroke. Conclusion: Beliefs related to spiritualistic fatalism as well as fear of calling 911 are powerful barriers to acute stroke care among FilAms. The results can inform a culturally-relevant intervention for the community using social media, the Internet, and Filipino television programs to encourage FilAms to obtain acute stroke care. Data collected is currently being integrated into a FilAm stroke media tool. Lessons learned from this project will also be used to create stroke education for other U.S. Asian Pacific Islander communities.

Building Gardens: Food Justice, Community Engagement, and Gardens for the Asian Pacific Islander Community in the San Gabriel Valley

Culturally relevant gardens can significantly benefit regions like the San Gabriel Valley, which contain nearly a third of Asian Americans who are low income, by providing organically grown produce for students (Asian Americans Advancing Justice, 2018). This article focuses on one service-learning program: Asian/Asian American Studies 3510 Food Justice, the Body, and the Environment in the API Community at Cal State LA that works with schools throughout the San Gabriel Valley to build culturally relevant produce gardens. While our work focuses on building gardens and considerations of food justice, one of the greatest barriers to community-university partnerships is the lack of procedural transparency embedded within the university structure and culture. The heart of this essay is this process.

Ambient Volatile Organic Compounds and Racial/Ethnic Disparities in Gestational Diabetes Mellitus: Are Asian/Pacific Islander Women at Greater Risk?

US Asian/Pacific Islander (API) communities experience high air pollution levels. APIs may be predisposed to pancreatic β-cell dysfunction and have the highest prevalence of gestational diabetes mellitus (GDM) compared with other racial/ethnic groups. Exposure to high levels of volatile organic compounds (VOCs) impairs pancreatic β-cell function, leading to insulin resistance, but racial/ethnic differences in this association are unexamined. We analyzed singleton deliveries (n = 220,065) from the Consortium on Safe Labor (2002-2008). Exposure to 14 VOCs in each hospital referral region was based on modified Community Multiscale Air Quality models. Logistic regression estimated odds ratios for GDM associated with high (≥75th percentile) versus low (<75th percentile) VOC exposure 3 months before conception and during the first trimester of pregnancy. Preconception and first-trimester exposure to high VOC levels was associated with increased odds of GDM among whites and APIs. GDM risk was significantly higher for APIs than whites for most VOCs. Preconception benzene exposure was associated with 29% (95% confidence interval: 12, 47) increased odds of GDM among whites compared with 45% (95% confidence interval: 16, 81) increased odds among APIs. These findings highlight environmental health disparities affecting pregnant women. Increased focus on GDM risk in US API communities is warranted.

Perception and Barriers to CalFresh Utilization Among Asian Pacific Islander Communities in Southern California

The Supplemental Nutrition Assistance Program (SNAP), formerly known as the Food Stamp Program, is a domestic hunger safety net that provides money for low‐income individuals. The program serves to reduce the risk for food insecurity by increasing individuals' purchasing power for nutritious food, and simultaneously providing economic benefits to local communities. In California, SNAP is known as “CalFresh”. California is tied with Wyoming for having the lowest SNAP participation rate among all states. According to the California Budget and Policy Center, the share of Californians in poverty is higher than those receiving food assistance. California has a largest population of Asian and Pacific Islanders (APIs), at about three times the national population, but CalFresh data suggest API ethnic groups constitute less than 7% of households utilizing CalFresh benefits. The California Health Interview Survey found extremely small percentages of various Asian ethnic groups actually receiving food stamps, even when they qualified. For example, only 4.5% of the qualifying Korean population reported utilizing CalFresh benefits. While Los Angeles County is home to some of the largest API communities, only a small percentage of the eligible residents are capitalizing on CalFresh benefits. This translates to missed opportunities for low‐income API residents to purchase healthy foods like fruits and vegetables. While the need to understand SNAP participation in low‐income immigrant communities has been noted in the public health literature, currently there is a paucity of research on API and their utilization of SNAP benefits. The purpose of this study was to examine perceptions of and barriers to CalFresh participation. We conducted focus groups with Tongan, Korean, Filipino, and Vietnamese community members and community‐based organization (CBOs) service providers around Los Angeles County. These four API sub‐groups were chosen because of their low participation rates among those who qualified. In addition to focus groups, surveys were also administered to CBO service providers to gain additional insight from those working directly with these API communities. While data collection is currently on‐going, preliminary results from focus groups suggest that pride and a deep sense of self‐sufficiency were key barriers to participation in the CalFresh program. Additionally, structural barriers including a lack of in‐language material and a long and complicated application process prevented many from participating in CalFresh. These preliminary findings suggest the need to program culturally specific interventions to mitigate these barriers in order to improve SNAP participation rates among low‐income immigrant API groups. Consequently, this work has the potential to improve CalFresh utilization in low‐income immigrant API communities, thus helping to reduce health disparities.Support or Funding InformationThis project is funded by the Pepperdine Seaver Research Council Grant, 2016–2017.

Capability for Change at Community Health Centers Serving Asian Pacific Islanders: An Exploratory Study of a Cancer Screening Evidence-based Intervention

Understanding and enhancing change capabilities, including Practice Adaptive Reserve (PAR), of Community Health Centers (CHCs) may mitigate cancer-related health disparities. Using stratified random sampling, we recruited 232 staff from seven CHCs serving Asian Pacific Islander communities to complete a self-administered survey. We performed multilevel regression analyses to examine PAR composite scores by CHC, position type, and number of years worked at their clinic. The mean PAR score was 0.7 (s.d. 0.14). Higher scores were associated with a greater perceived likelihood that clinic staff would participate in an evidence-based intervention (EBI). Constructs such as communication, clinic flow, sensemaking, change valence, and resource availability were positively associated with EBI implementation or trended toward significance. PAR scores are positively associated with perceived likelihood of clinic staff participation in cancer screening EBI. Future research is needed to determine PAR levels most conducive to implementing change and to developing interventions that enhance Adaptive Reserve.

Sexual and Reproductive Health Behaviors of Asian Pacific Islander Community College Students

Analyzed were the sexual and reproductive health behaviors of Asian Pacific Islander (API) California community college students who took the National College Health Assessment (NCHA) survey. This was done to identify characteristics related to sexual behavior and choice of birth control and examine the association between condom use and history of HIV testing. A total of 769 API heterosexual, male and female students between ages 18–24 were included in the analysis. Chi-square analyses were conducted to determine whether there was an association between condom use and history of HIV testing. API students reported few sexual partners (41% with no partner, and 49% with 1 or 2 partners), and preferred condoms (53.0%) for birth control over hormonal methods (29.3%). One-fifth of API students have used emergency contraception, and 21.7% have had an HIV test. API students had more conservative sexual practices and lower HIV testing practices than community college students in general. More culturally tailored education is needed on contraceptive options and to increase HIV testing behaviors among APIs.

Asian Community Mental Health Services at 35: A Pioneering Ethnic Organization (1973–2008)

Asian Community Mental Health Services is a nonprofit organization that delivers mental health services to primarily Asian and Pacific Islander communities. From its early beginnings and over its 35-year history, the agency has had to overcome numerous challenges, including gaining legitimacy as a culturally specific nonprofit, combating stigma surrounding mental health issues within the Asian Pacific Islander community, building resources to fund service delivery, and developing an educated and culturally sensitive workforce. The history of the organization highlights the multiple challenges and rewards of developing a culturally specific nonprofit in an urban area as well as the important role that internal operations play in relation to nonprofit expansion and growth.

Building Capacity for HIV/AIDS Prevention Among Asian Pacific Islander Organizations

This article has two goals: (1) to outline a conceptual model for culturally appropriate HIV prevention capacity building; (2) to present the experiences from a 3-year program provided by Asian Pacific AIDS Intervention Team to Asian Pacific Islander (API) organizations in southern California. The participating organizations were of two types: lesbian, gay, bisexual, transgender, and questioning (LGBTQ) social organizations and social service agencies not targeting LGBTQ. These organizations were selected for participation because of their commitment to HIV/AIDS issues in API communities. An organizational survey and staff observations were used to explore changes in capacity. The organizations were mostly small, targeted diverse populations, served a large geographic area (southern California as a region), and were knowledgeable about HIV. Organizations became more viable (more capacity in human resources, financial, external relations, and strategic management), but also more unstable (large growth in paid staff and board members), and showed more capacity in HIV knowledge environments (especially less stigma and more sensitivity to diverse populations). The results suggest that capacity can expand over a short period of time, but as capacity increases, organizational viability/stability and HIV knowledge environments change, meaning that different types of technical assistance would be needed for sustainability.

Responding to Asian Pacific Islander Youth Violence: Lessons Learned From a Community Mobilization Strategy

Youth violence in Asian Pacific Islander (API) communities is growing at an alarming rate as a result of many factors, such as immigration history, intergenerational conflicts, mental health and substance abuse problems, and socioeconomic context. Unfortunately, the issues of API youth are often ignored due to their small population and a general lack of understanding of this group. This article describes a federally funded, API community mobilization effort to prevent youth violence in Oakland, California. Literature is briefly summarized, followed by descriptions of the history, context, process, and outcomes of the community mobilization—a process called the Community Response Plan.

Etiology and prevention of substance use among Asian American youth.

Among populations identified by the U.S. Bureau of the Census, it is anticipated that the Asian/Pacific Islander (API) population will experience the greatest change between 1990 and 2050 (U.S. Bureau of the Census. [1996, February]. Current population reports. Series P25-1130. Washington, DC: U.S. Government printing office). Limited studies focus on APIs as a racial group and still fewer disaggregate samples to specific ethnic Asian subgroupings. This paper begins with definitions of the API communities, then examines rates of adolescent drug use, risk and protective factors, and preventive intervention effectiveness focused on API communities. The limited epidemiological data suggest that in general, APIs are at a relatively lower risk for drug use than youth from most other ethnic groups. However, the available data also suggest that use may not be as low as generally assumed with rates for alcohol use, smoking, and some illicit drugs being equal to or exceeding those of African Americans and European Americans. Despite the paucity of available data on particular Asian subgroups, the available data demonstrate that there are differences among API subgroups, underscoring the importance of identifying Asian subgroups when studying substance use and when planning prevention and treatment. The limited data examining the etiology of drug use across API subgroups suggests that some of the risk and protective factors derived from majority based research may also be predictors for these populations. These data support the utility of examining the generalizability of existing tested prevention approaches among different API communities. Finally, further efforts should be made to encourage and support the evaluation of community-based programs that already target and deliver services to API youth.

Racialization, Recognition, and Rights: Lumping and Splitting Multiracial Asian Americans in the 2000 Census

THE 2000 CENSUS WILL MARK a dramatic change in the way that “race” is officially enumerated in the United States to allow people to check more than one race. This is a significant change for the way people do and understand the concept of race, and will have potentially far-reaching effects for multiracial Asian Americans, Pacific Islanders, and Asian Pacific Islander communities. The Census, as a representation of the state, is an ideal place to see how race is changing both practically and conceptually as people lobby the Census Bureau to change racial categories to accurately reflect their multiracial understanding.1 In this article, I examine the impact of changing the Census to allow people to check more than one race box on Asian Pacific Americans (APAs). Race is now widely recognized as being a contested and changing, socially constructed category.3 As historical proof of this, APAs have long been unable to fit the racial labels used by the U.S. government to classify them. For example, the plaintiffs in the infamous cases of Ozawa v. United States, 260 U.S. 178 (1922) and United States v. Thind, 261 U.S. 204 (1923) failed in their attempts to be considered “not Asian, Caucasian/white” in order to become naturalized citizens of the U.S. Those cases foreshadowed a legal framework that would continue throughout the 1900s to remind APAs that they were racially different, not white, and therefore ineligible for American citizenship.4 There has never been a comfortable fit historically for Asian Americans with racial categories used by the U.S.

Integrating Buddhism and HIV prevention in U.S. southeast Asian communities.

Asian Pacific Islander communities in the United States have experienced an alarming increase in HIV infection over the past few years, possibly due to a lack of knowledge and the relative absence of appropriate educational interventions. The authors propose a new approach to the development of HIV prevention programs in U.S. southeast Asian communities. This article reviews the cultural and economic factors that may facilitate HIV transmission within these communities. Relying on the basic precepts of Buddhism, the dominant religion of many southeast Asian populations in the United States, the health belief model is utilized to demonstrate how recognizable, acceptable religious constructs can be integrated into the content of HIV prevention messages. This integration of religious concepts with HIV prevention messages may increase the likelihood that the message audience will accept the prevention messages as relevant. This nuanced approach to HIV prevention must be validated and refined through field research.

Hepatitis B immunization of Asian Pacific Islanders in the United States.

There are numerous strategies recommended in the United States for control of the hepatitis B virus, including universal vaccination of infants and adolescents and vaccination of all high risk populations. A recent hepatitis B vaccination program conducted in Philadelphia, PA, focused on effective ways to educate and vaccinate the high risk Asian Pacific Islander population. Multiple intervention activities were used for both health care providers and Asian Pacific Islander community members, including one-to-one educational programs. Intervention activities did increase hepatitis B vaccination coverage to 34%, but coverage increase was less than has been shown with other programs. The intervention program, however, may have a long-lasting positive impact on vaccination coverage because postintervention, study participant health care providers began to offer a more flexible vaccination delivery system. It is likely that the total cost of $135943 for all intervention activities will prevent future costly cases of chronic hepatitis B and its serious related sequelae among this high risk population.

HIV prevention in U.S. Asian Pacific Islander communities: an innovative approach.

Few HIV prevention efforts have focused on Asian Pacific Islander communities in the United States. Prevention messages developed for the general U.S. population have failed to reach many Asian Pacific Islanders. This article describes the development of an HIV prevention strategy for Asian Pacific Islanders through health care workers. This strategy was based on the ecological disease theory and action research methodology. The prevention program comprised four components: (1) a symposium for the health care workers, (2) a culturally sensitive and appropriate HIV-related video for the health care workers and their patients, (3) ongoing training of the health care providers, and (4) ongoing liaison and consultative services for the health care providers. The intervention is intended to encourage HIV risk-reduction behaviors among the patients, to encourage the HIV testing of those who may be at risk for HIV, and to facilitate access to services for those found to be infected.